Highgrove Surgery

We carried out an announced comprehensive inspection of Highgrove Surgery on 5 February 2020 as part of our inspection programme.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 3 December 2018. At the last inspection in December 2018 we rated the practice as requires improvement overall.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected;
• information from our ongoing monitoring of data about services; and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall.

We rated the practice as inadequate for providing safe services because:

• The practice’s failsafe system to monitor cervical screening results was ineffective.
• There were gaps in staff training in relation to safeguarding, fire safety, basic life support and infection control.
• Staff could not find up to date safeguarding polices on the practice’s computer system.
• The practice had not assessed the need for certain medicines to be kept for use in an emergency, and there was no record of checks of the oxygen cylinder. We found expired medicines and medical equipment and products.
• There was no system to monitor blank prescriptions distributed within the practice.
• Vaccines were not kept securely.
• There was no evidence of up to date portable appliance testing.
• Where risks had been identified from premises assessments and checks, the practice did not know and could not evidence these actions had been addressed by the building management (NHS Property Services).
• There was no record of immunity status for some staff members.
• One of the clinicians did not have appropriate indemnity cover in place.

We rated the practice as requires improvement for providing responsive services because:

• There was little patient access to a female sample-taker for cervical screening.
• Patient feedback was generally positive about the practice, except in relation to access. Patients told us it was difficult to get an appointment.
• Complaints investigations were cursory and required more detailed investigation to analyse the cause of the issues being raised.

These areas affected all population groups, so we rated all population groups as requires improvement for providing responsive services

We rated the practice as requires improvement for providing well-led services because:

• Although staff described leaders are visible and approachable, the practice’s overall governance arrangements did not always operate effectively.
• There was a lack of oversight of safety systems and checks related to the premises.
• There were missing policies, and some policies had not been updated in line with specified timeframes or did not contain all the necessary information.
• Some of the systems to identify and manage risks and issues were not operating effectively, for example in relation to the cervical screening failsafe, the staff training matrix, and checks of medicines and equipment.
• Cursory investigation of complaints meant that the practice was not using the complaints process effectively to adjust and improve systems and performance.

We rated the practice as good for providing effective services because:

• Care and treatment was delivered in line with current legislation, standards and evidence-based guidance.
• The practice reviewed and monitored the effectiveness and appropriateness of the care and treatment it provided through a programme of quality improvement activity.
• There was effective clinical oversight from the GP partners.
• Staff were consistent and proactive in helping patients to live healthier lives.

These areas affected all population groups, so we rated all population groups as good for providing effective services, except for ‘working age people’ which we rated as requires

improvement due to the ineffective cervical screening failsafe system.

We rated the practice as good for providing caring services because:

• Staff treated patients with kindness, respect and compassion.
• Feedback from patients was generally positive about the way staff treated people.
• Staff helped patients to be involved in decisions about care and treatment.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue to improve uptake rates for childhood immunisations and cervical screening.
• Improve the system for recording safety alerts to make it easier for staff to monitor and evidence the action taken by the practice.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Highgrove Surgery on 03 December 2018 as part of our inspection programme.

At the last inspection in November 2016, we rated the practice as good overall.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall because:

• Most medicines were prescribed, administered or supplied to patients in line with current national guidance. However, the provider did not have an effective system in place for monitoring patients on high risk medicines.
• The practice had a health and safety policy but this was not operating as intended. The partners were responsible for the health and safety in the practice. The practice had not risk assessed the need for carrying out their own safety checks in the surgery environment, independently from checks performed by Barking Hospital’s NHS property services.
• The practice had a training matrix to record the dates staff had completed training and the renewal dates for annual training. However, this had not been maintained and some entries on the staff training matrix were not consistent with the dates on training certificates. There was no record of safety training for the salaried GP who worked at the practice.
• At our inspection we found Childhood immunisation uptake rates were below the World Health Organisation (WHO) target percentage of 90% or above in three of the four target areas.
• There was a system to manage infection prevention and control, but this did not mitigate all of the risks.
• The practice did not have a system to monitor patient feedback. At this inspection the practice told us they had not reviewed the 2018 results from the GP National Patient Survey, and had not independently undertaken any alternative patient satisfaction monitoring.
• The practice did not have safe systems to monitor and track blank prescriptions.

The overall rating for this practice was requires improvement due to concerns in providing safe, effective and well-led services. The population groups were rated as requires improvement for people with long term conditions and families children and young people because there were concerns about timely review of patients on high risk medicines and figures showed the practice performance was below average/national targets, with no substantive plans to improve.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Improve uptake of childhood immunisations and cervical screening.
• Maintain the record of entries in staff training matrix against certifcates of training.
• Review the availability of practice information in easy read format.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice